Women with heavy periods may have an undiagnosed bleeding disorder

Jun 3 2009

According to researchers in the United States many women suffer from bleeding disorders, but are unaware they have one because doctors are not looking for the condition.

But that is about to change as an international group of experts have produced an outline of the definitive signs that may signal the presence of a bleeding disorder in women and the new guidelines are not just aimed at doctors as the authors say women who suffer from heavy menstrual cycles should also be on the lookout for the signs.

Dr. Andra James, an obstetrician at Duke University Medical Center, says about 25% of women with heavy menstruation may have an undiagnosed bleeding disorder and she says heavy bleeding should never be ignored.

Dr. James, the paper's lead author says when a woman's blood cannot clot normally the most obvious sign is a heavy period yet when faced with this scenario, most doctors do not suspect a blood clotting problem is to blame.

Dr. James says sometimes the culprit is suspected to be hormones or fibroids and in some cases the removal of the uterus is recommended or another gynecologic explanation when the real contributing factor is a blood clotting disorder.

Dr. James says research has shown that women who were ultimately treated for a bleeding disorder reported waiting 16 years, on average, before being properly diagnosed and in extreme cases, the undiagnosed bleeding disorders have led to women bleeding to death during menstruation, childbirth and surgical procedures.

Dr. James says the most common inherited bleeding disorder is von Willebrand disease, of which she has expert knowledge and common criteria for diagnosis include the presence of a family history of bleeding, personal history of bleeding and laboratory tests that indicate the lack of a protein called von Willebrand factor which is essential for clotting.

Without the laboratory test, the consortium says women and doctors should be on the lookout for the following:- heavy blood loss during menstruation, a family history of bleeding disorder, notable bruising without injury, minor wound bleeding that lasts more than five minutes, prolonged or excessive bleeding following dental extraction, unexpected surgical bleeding, hemorrhaging that requires blood transfusion and hemorrhaging after giving birth, especially if occurs more than 24 hours after delivery.

Dr. James says all too often women think heavy bleeding is normal because the women in their family - who may also have an undiagnosed bleeding disorder - have heavy periods as well.

James says women who continually experience abnormal reproductive tract bleeding, specifically heavy menstrual bleeding, must be alert to these other signs and approach their doctor about being evaluated - she also says doctors should be asking the right questions and ordering appropriate laboratory tests in suspected patients.

Dr. James says that not every patient who has abnormal reproductive tract bleeding has a bleeding disorder, and while most don't, up to one-quarter do, and this needs to be recognized and treated, so these women can experience normal periods and go through childbirth safely.

The consortium's recommendations are published online and will appear in the July issue of the American Journal of Obstetrics and Gynecology.